When Do Dental Implants Become A Medical Necessity?

Posted on

Dental implants often fall under the category of "cosmetic" dentistry. Because of that, many insurance carriers consider missing teeth a non-medical issue. Dental insurance companies rarely or only partially cover implant procedures. However, if your dental implants are a medical necessity, they transcend the cosmetic definition and become something that your medical insurance can cover.

Establishing Medical Necessity for Dental Implants

Check your medical insurance for their policies regarding dental procedures. In most cases, you find that medical carriers usually do not support routine dental care, dental support procedures, or dental surgeries. But if you continue to read closely, you will likely see some clauses for when dental procedures are in fact covered by medical insurance.

These clauses can vary from carrier to carrier. In general, if your body and its functions will suffer negatively without some kind of dental work, then your insurance may cover it. As you search, you may see clauses such as:

These headings and others like them will outline what the medical insurer considers coverable and what they will not consider as coverable. They also have very strict criteria with which they lay out these restrictions.

For example, an infected tooth can lead to you not eating and becoming malnourished. Removing the tooth and replacing it with an implant will reverse the problem. In essence, it's a necessary medical procedure.

The flip side of the argument is true as well. Do you have a medical condition that can damage your teeth? These can include issues such as bulimia and Sjögren syndrome. These medical conditions sometimes make it possible for the medical insurer to cover the dental care associated with the illness.

Speak to the Dentist about It

Many people and even many dental practitioners do not know a lot about billing medical insurance for dental procedures. On top of that, many medical insurance companies do not make the process easy. Some dentist offices simply do not know how to process those medical claims. There are specific forms and codes that they may need to familiarize themselves with.

However, there are many dentists out there that do know how to intervene on your behalf to make it work for you. In fact, since implants are not considered routine care in most situations, it's usually a given that they're not covered by the average dental insurance plan. That means that you should start your search for dental implants with your medical insurance carrier from the very beginning. Talk to a clinic like New Image Cosmetic & Family Dentistry to learn more about dental implants and how to pay for them.